Organization
UP SUPERIOR ENTERPRISES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONALD ANTHONY GORDON (OWNER)
(906) 632-6736
Entity
Organization
Contact information
Practice address
2303 ASHMUN ST, SAULT SAINTE MARIE, MI 49783-3749
(906) 632-3772
(906) 632-0309
Mailing address
2675 ASHMUN ST, SAULT SAINTE MARIE, MI 49783-3711
(906) 632-3772
(906) 632-0309
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
00194T
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275740318
—
MI
01
—
540A70445
BLUE CROSS AND BLUE SHIELD
MI
Enumeration date
05/17/2007
Last updated
03/06/2018
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